The countries participating in the PIRLS included 9 of the 17 peer countries examined in Part I and, among these, the United States ranked fifth for combined reading literacy of fourth graders. Department of Education.
Since , the PISA has been administered every 3 years to year-old students to assess cognitive skills in reading, mathematics, and science and general problem-solving skills. A National Academy of Sciences et al. Students in the United States are not keeping up with their counterparts in other countries. In [PISA] measured the performance of year-olds in 49 industrialized countries. It found that U. In the most recent data available , U. Among the 17 peer countries, U. By , the U.
Hanushek and colleagues compiled data for 50 countries from to by standardizing the results of 12 PISA tests and other international mathematics and science assessments. In the s and s, U. The United States was outranked by 18 countries in the s including 10 peer countries , by 20 countries in the s including 9 peer countries , and by 23 countries in the s including 10 peer countries.
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By the s, Finland and nonpeer countries such as Korea, Taiwan, and Japan were the top performers Hanushek et al. OECD average were as follows: Reading est. The recession-related decline in employment between and was more abrupt in the United States than in many countries OECD, e , but unemployment rates in the United States have traditionally not exceeded those of other high-income countries since the s Nickell et al. Census Bureau, Census Bureau, , Multiple studies have demonstrated that the United States has less social mobility than other countries Blanden et al.
A report by the Brookings Institution Isaacs et al. Men born into the poorest fifth of families in the United States in had a higher likelihood of ending up in the bottom fifth of the earnings distribution than did males similarly positioned in five Northern European countries—42 percent in the United States, compared to 25 to 30 percent in the other countries. A follow-up study reported that one-third of Americans who grew up in the middle class fall below that category as adults Acs, Data are limited to compare housing instability in the United States and other high-income nations.
A telephone survey in Belgium, Germany, Italy,.
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The United States has the highest incarceration rate among affluent countries—approximately of every , U. Between and , year-end prison counts in the United States nearly tripled from , to 1,, Pew Center on the States, And within the United States, the rate of ever having gone to prison among males was more than six times higher among blacks than whites Bonczar, Department of Justice estimates that if incarceration rates remain unchanged, 6.
Between and , the percentage of U. By , 30 percent of U. The corresponding percentages in comparable countries—including Canada, Japan, Denmark, France, Germany, Ireland, Netherlands, Sweden, and the United Kingdom—also increased during these decades, but none had the high percentage of the United States.
In , A study that compared the United States with 16 other countries including 9 of the peer countries examined in Part I found that children born in the United States can expect to live more years with parents apart, with a single mother, without a mother, or in a maternal stepfamily than children in other countries Heuveline et al.
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Single-parent households have a greater need for some social services, such as day care, which are less available in the United States. The United States differs from other high-income countries in several social domains that relate to health outcomes 26 :. It is highly plausible—although not proven—that the social conditions discussed above have contributed to the U.
However, for reasons noted above, notably the lack of comparable evidence, this summary does not include differences among the United States and other countries in the magnitude of racial or ethnic disparities. It focuses on socioeconomic differences, for which data are more readily available, but the panel is acutely aware of the important additional role of race and ethnicity in the health profile of all high-income countries. We also note that the implications of the listed conditions can differ substantially across countries because of differences in social programs and the strength of safety nets.
In particular, overall poverty and child poverty are especially plausible explanations for the pervasive U.
Both have been markedly higher in the United States than in almost all other high-income countries during the years when people now in their 20s, 30s, or early 40s were born, growing up, or entering young adulthood. Conditions for children and young people during that period could have shaped risks for low birth weight and infant mortality among the babies born to that cohort, as well as risks for virtually all of the health conditions on which the United States has a disadvantage during the first three or four decades of life.
Adult poverty during the past three to four decades may even explain some of the health disadvantage observed among older U. Chapters 1 and 2 documented that the U. The high rates of poverty and child poverty in the United States would not explain the persistence of the problem in these advantaged groups, although it is possible that social inequality itself contributes to or reflects conditions that affect the entire population.
Similarly, it is plausible that racial inequality in the United States compounds the societywide effects of economic inequality with which it is intertwined, but empirical cross-national data on this dimension of social inequality are unavailable. The large incarcerated population in the United States suggests a profound degree of multidimensional social disadvantage that affects many people—not only prisoners themselves but also their families and communities Wildeman and Western, Racially disproportionate incarceration rates in the United States are probably reflections of multiple societal problems and are a likely contributor to the health risks associated with poverty and to social immobility.
This phenomenon is chiefly manifested in the United States as the so-called Hispanic paradox, in which Hispanic Americans tend to have better health outcomes than people born in the United States, especially within 10 years of immigration Markides. The phenomenon has also been documented among black immigrants from Africa and the Caribbean Collins et al. Differences in child care and preschool education in the United States could have broad effects that reach beyond disadvantaged groups. Strong evidence demonstrates that high-quality child care and early childhood development programs from infancy through age 5 lead to higher educational attainment, income, and employment rates in adulthood, and lower rates of criminal behavior.
Although the benefits of preschool education are greater for poor children than others, they have been demonstrated among children of diverse socioeconomic backgrounds; and the benefits are themselves strong predictors of subsequent health Karoly et al. The mixed but overall mediocre—and in some cases very low—comparative standing of the United States on educational attainment and measures of educational achievement in secondary and tertiary education may contribute to the U.
That the United States once led the world on educational attainment and has a highly educated cohort of older adults, however, makes education a less likely contributor to the health disadvantages currently observed among older Americans. They were educated many decades ago, when their counterparts in other high-income countries did not, as a group, hold an educational advantage.
Inequalities in life expectancy and all-cause death rates among Americans with different levels of education and income have been increasing for decades Dow and Rehkopf, ; Jemal et al. In an examination of mortality rates by educational attainment among adults aged , mortality rates among white men were higher in the United States than in England and Wales, France, Norway, Sweden, and Switzerland, but the excess mortality was more pronounced in lower than in higher educational groups Avendano et al.
For example, although mortality among U. The authors concluded that part of the excess mortality among U.
A variety of hypotheses could explain this pattern, among them that prosperity in the United States may be more deeply tied to higher education Cutler et al. The consequences of inadequate educational attainment may differ by country, depending on the educational credentials required for desirable jobs, economic security, and other material and psychosocial benefits gained through employment.
In comparison with the United States, only Poland, Portugal, Spain, and Turkey have similarly low rates approximately 20 percent or less of skilled employment among employed persons who lack tertiary schooling, indicating the larger socioeconomic consequences in the United States of not having a tertiary education OECD, b. The health benefits associated with education might be stronger in the United States than in other countries.
A recent study reported that life expectancy among people with less than 12 years of education decreased in the United States between and , at the same time that it increased among people with 12 or more years of education Olshansky et al. Underscoring the importance of education, the study also found that blacks and Hispanic Americans with 16 or more years of education lived 7.
Their disadvantage also could be exacerbated by deficiencies in health during childhood and young adulthood Fletcher and Richards, Another factor that could compound the effects of low income and education is the comparatively weak social safety net i. A weaker safety net may exacerbate the detrimental health effects of poverty, unemployment, and economic insecurity Bartley et al. The health effects of unemployment may be buffered, for example, by programs that provide job training and counseling, medical care, and income and housing supports for the unemployed Bartley and Owen, In one recent study, prospective data from the United States and Germany covering to showed that unemployment was associated with higher mortality in the United States but not in Germany.
This relationship was only evident among low- and medium-skilled workers, prompting this analysis by the authors McLeod et al. In the American cohort there was no relationship between unemployment and mortality for the high-skilled. It appears that individuals with a high level of education may be best suited to take advantage of the more flexible labor markets within the United States.
The high-skilled were also more likely to receive benefits, when unemployed, than were those of lower skill levels. These individuals may also have other resources e. In Germany, the unemployed medium-skilled had the lowest relative risk of dying. This is the strongest evidence that institutional environment can affect the relationship between unemployment and health as institutional protection is targeted toward medium and vocationally skilled workers in Germany.
The health consequences of low income may be mitigated by other resources that help individuals and families meet their basic needs Anand and Ravallion, , such as free or subsidized food, medical care, child care, elder care, education, housing, public transportation, recreational services e.
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A study of 18 countries documented that social security transfers and public health spending significantly reduce poverty levels Brady, As with other social factors, child poverty could potentially have more severe adverse health consequences in the United States than in other affluent nations. Greater public investments in child and family supports—including child care, early childhood development, and preschool programs see Chapter 8 —appear to help alleviate the effects of child poverty in other countries.
After counting income from both the market and the welfare state, The difference in disposable income poverty rates. Over the mids, child poverty increased by almost one-third in the United States from 9. The relatively weak social safety net in the United States is a potential explanation not only of a health disadvantage among low-income children and a contributor to low social mobility, but also of the health disadvantages observed among children in all income groups.
Stronger safety nets could, at least in theory, lessen the stress and anxiety associated with a potential loss of income or the high costs of medical care, child care, and education Bartley et al, Safety net programs, the quality of schools, and economic conditions in the United States are shaped in part by public policies, such as the relatively low public spending on services for families and young children compared with other high-income countries. The role of public policies in shaping social conditions is discussed further in Chapter 8.
Part I of this report documents that life expectancy and other health outcomes e. During this same time, as this chapter notes, there has also been a potentially important co-occurrence of worsening social conditions in the United States, notably a rise in income inequality, poverty, child poverty, single-parent households, divorce, and incarceration—all more pronounced than in other rich nations—and the loss of the U. Like the U. Whether these co-occurring social trends, individually or in combination, were causally related to the increasing U.
Answering this question requires a careful examination of historical data to make relevant cross-national comparisons on a range of social conditions over several decades. The cross-country rankings on social indicators discussed in this chapter reflect relatively recent data since the.
As discussed further in Chapter 8 , European studies have shown that although stronger safety nets are consistently associated with better aggregate health in countries, they do not necessarily correlate with the size of health inequalities within European countries Kunst et al.